Mansur Shomali, MD, CM, is a practicing endocrinologist at Medstar Union Memorial Hospital in Baltimore, Maryland. He actively trains the next generation of physicians as a faculty member at the University of Maryland School of Medicine and serves as Welldoc’s Chief Medical Officer overseeing clinical aspects of our digital health solutions. From Dr. Shomali’s unique vantage point he offers guidance on this topic.
How do you see digital therapeutics, like BlueStar, impacting your medical practice and medical practice in general today?
Dr. Shomali: We know that the use of technology in healthcare is now in its embryonic stage. At present healthcare providers, including physicians are often forced into using clunky electronic health record (EHR) systems. Patients download and attempt to use tracker apps that have limited clinical value. The number of digital therapeutics, like Welldoc’s type 2 diabetes mobile medical app BlueStar, designed by clinical and technology experts, FDA-cleared, and have evidence to support their use, are increasing. The array and number of digital therapeutics will increase over time and promise to take the use of technology in medical practice to a new level. We already know that digital therapeutics have the power to amplify the effectiveness of the treatments while making monitoring a person’s progress and follow up care much more efficient and satisfying for both the provider and patient.
How has the availability of digital therapeutics changed the way you practice and interact with your patients? Has this changed the quality of interactions you have with patients and changed their interactions with you?
Dr. Shomali: Knowing that the people under my care are more engaged with their treatment plan and learning how to troubleshoot problems is very reassuring. For example, people with diabetes who use BlueStar, can more easily track and alert a provider if need be between visits. The reality of practice today is that providers have limited face-to-face time with patients. So it’s huge if I help them leave my office with a sophisticated product that supports the treatment plan that we’ve agreed to implement. In addition, having all of their relevant data available and summarized for me makes the time we do have during face-to-face visits more effective. It enhances my ability to solve problems over phone calls in between visits. I find the Smart Visit Report in the BlueStar product invaluable in working with people with type 2 diabetes.
What are the different skills you believe the next generation of physicians need to develop to integrate digital therapeutics into medical practice?
Dr. Shomali: I don’t know that the next generation of healthcare providers will need different skills. From my observations they’re already really good with technology. What they will need to know is how to access and assess the best digital therapeutics available to assist them and their patients to manage the various disease states. They’ll also need to know how to determine the ideal digital therapeutic for the variety of patients they see. In my mind what future, and even current practitioners, need is more infrastructure and support within their practice. This includes all the support personnel in medical practices. Medical practices may want to identify and train support personnel to become the practice’s digital therapeutic champion. This person would take a leadership role to gain knowledge on the digital therapeutics in use and how to integrate them into the practice work flow and to maximize their use by patients. A note of caution from my experience, if the digital therapeutic will add more burden to the healthcare provider or will be used sub optimally by the patient, then its full potential cannot be obtained. This includes patient self-care and treatment optimization to achieve positive clinical outcomes.
What do you observe are the most impactful aspects of integrating a digital therapeutic into clinical care? How does it change the patient-provider relationship?
Dr. Shomali: Digital therapeutics enhances patient care for all of the reasons I mentioned above. If digital therapeutics is implemented properly, they have the potential to facilitate patient-provider communication and patient-provider satisfaction. I think patients genuinely appreciate the ongoing support that digital therapeutics can provide.
Look into your crystal ball and envision how you think digital therapeutics will change the physician practice/chronic disease care in five years, ten years.
Dr. Shomali: With the shortage of disease specialists and the increase in the prevalence of chronic diseases, digital therapeutics will help close that gap. Primary care providers will be able to manage patients more expertly, reserving the specialty referrals to those people who need it the most. Digital therapeutics will act like virtual care coordinators, coaching their patient users to achieve optimal self-management. They will be able to direct the digital therapeutic user to the most appropriate human healthcare provider, perhaps a specialist, primary care provider, educator, and/or trainer) when the human touch is required.
What are the biggest challenges to physicians to reach this new reality?
Dr. Shomali: First, technology companies have to design and build their digital therapeutics more intelligently. We have to learn from the lessons of the first generation EHRs. Digital records were a good idea but the implementation made work flow for healthcare providers more difficult. Simple tasks that took seconds, like writing a prescription or documenting a progress note, took minutes. Different systems within the work flow of medical practice and beyond need to communicate with each other seamlessly. Second, the healthcare system has to be able to adopt and implement technology to enable this seamless communication.
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